Provider Demographics
NPI:1477502151
Name:HETZ, STEPHEN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:HETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WBAMC, 5005 N. PIEDRAS STREET
Mailing Address - Street 2:ATTN: CREDENTIALS OFFICE, RM 10036
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-569-2107
Mailing Address - Fax:915-569-1233
Practice Address - Street 1:5005 N. PIEDRAS STREET
Practice Address - Street 2:ATTN: CREDENTIALS OFFICE, RM 10036
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-569-2107
Practice Address - Fax:915-569-1233
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery